Bradycardia Hospital Ischemia 
Dr. Smith's ECG Blog
OCTOBER 7, 2019
Both of these features make inferior + RV MI by far the most likely ( Pseudoanteroseptal MI is another name for this ) There is also sinus bradycardia and t he patient is in shock with hypotension. A narrow complex bradycardia without any P-waves is also likely to respond to atropine, as it may be a junctional rhythm.
Dr. Smith's ECG Blog
JULY 21, 2024
The patient was extubated on Day-3 of the hospital stay. The patient improved, and on Day-11 of the hospital stay — he was off inotropes and on a small dose of a ß-blocker. There is no definite evidence of acute ischemia. (ie, Some residual ischemia in the infarct border might still be present.
Dr. Smith's ECG Blog
AUGUST 11, 2024
Below is the first ECG recorded by paramedics after 2 hours of chest pain, interpreted by the machine as “possible inferior ischemia”. There’s competing sinus bradycardia and junctional rhythm, with otherwise normal conduction, borderline right axis, normal R wave progression and voltages. What do you think?
Dr. Smith's ECG Blog
OCTOBER 18, 2023
A few days into her hospital stay she developed chest discomfort and the following ECG was recorded. The ECG below was on file and was taken a few days earlier, on the day of admission to the hospital. Most such rhythms in the setting of ischemia are VF and will not convert without defibrillation. What do you think?
Dr. Smith's ECG Blog
OCTOBER 25, 2023
A prior ECG was available for comparison: Normal One might be tempted to interpret the ST depression as ischemia, but as Smith says, "when the QT is impossibly long, think of hypokalemia and a U-wave rather than T-wave." The patient was admitted to the ICU for close monitoring and electrolyte repletion and had an uneventful hospital course.
Dr. Smith's ECG Blog
OCTOBER 20, 2024
The first task when assessing a wide complex QRS for ischemia is to identify the end of the QRS. The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch). What do you think?
Dr. Smith's ECG Blog
FEBRUARY 6, 2024
The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Between 81-95% of life-threatening ventricular dysrhythmias and acute cardiac failure occur within 24-48 hours of hospitalization. Chest trauma was suspected on initial exam. See this case , this case , and this case.
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